Grief vs Depression in loss

By Dr Kumari Valentine

October is Pregnancy and Baby Loss awareness month. As a clinical psychologist, one of the questions I get asked is about what “normal” grief is and when one might consider seeking help. I’ll outline some differences between grief and depression and when is grief depression? Although we may expect that depression might be synonymous with grief or that depression might follow grief, this is not the case.

Here are the cardinal symptoms of depression that we typically see, when making a diagnosis from the American Psychiatric Associations Diagnostic and Statistical Manual (now in its 5th Edition; DSM 5). Sadness (or irritability) is present for at least two weeks, more often than not. In addition, there can be changes in weight or appetite,Â intense thoughts of guilt, feeling very worked up or slowed down, trouble with concentration, trouble with motivation, difficulties with sleep (sleeping too little or sleeping too much), and a profound lack of interest in activities that may have previously been enjoyed. One of the symptoms of depression to be especially on the lookout for is suicidal thinking. Research shows that even symptoms that don’t quite meet criteria for a disorder can really affect someone’s functioning and impair quality of life. If in any doubt at all, I strongly urge you to consult a health professional whether for yourself or taking the person you are concerned about. Early monitoring and intervention is vital.

While it can be very difficult to separate depression from grief, DSM 5 gives us some useful points of difference: in grief, sadness comes in waves, intermingled with positive experiences. We are still able to enjoy things and smile. In grief, self-esteem is intact. In depression, severe self-doubt, thoughts of worthlessness and self-criticism are common. You can see though, that following pregnancy loss, it might be easy to start self-blame and criticism and to have a huge confidence knock. In my experience, people who are grieving without depression also have a sense that what they are experiencing is normal and understandable. Feeling invalidated (whether by oneself or others) though, may make grieving extremely difficult and set someone up to enter the negative spiral of depression. For this reason, and more, I believe it is vital that we talk about pregnancy related loss and validate grief. Having depression in addition to grief makes for a more severe experience and a more complicated recovery.

There are dangers of incorrectly labeling depression and beginning treatment when, in fact, what someone needs is reassurance that their experience is normal, even if what they’ve experienced is extreme loss.Â Emotional validation is absolutely vital. It can also be tempting to avoid seeing a professional for “normal” grief. In my experience, most people benefit from talking to a kind person who is neutral and able to offer compassion and a space to reflect, cry, be angry, be sad, and just BE. A professional you trust can also offer strategies to make coping easier.

A diagnosis of depression is not necessary to be doing things proactively to care for oneself during any stressful time, especially when dealing with stressors including grief. Some things include talking to someone you trust, practicing being present (when sad, our mind tends to go back towards the past and torture us with what we should have done), trying for healthy sleep, eating regularly, and turning down that self-critical voice.